ORNGE is casting a dark shadow on Deb Matthews’ moment in the spotlight as an agent of change in the health ministry.

ORNGE is sucking up all the oxygen in the minority Legislature, suffocating the other major issue that was supposed to dominate the agenda: Ontario’s declining fiscal health and a prescription for economic recovery.

The Liberals had cast Health Minister Deb Matthews in a starring role on the fiscal front — acting as an agent of change by transforming her ministry.

Her debut came in a speech last month heralding major reforms in the delivery of health services. And she was cued up for an even bigger leadership role after the Drummond report on Ontario’s deficit squeeze — with its 105 detailed recommendations for the health sector.

That was then — when it was all about red ink. This is now — and it’s all about ORNGE, the air ambulance service that went into a tailspin on her watch.

So far, Matthews has been sidetracked, but not sidelined. Premier Dalton McGuinty is sticking by her, not just for the usual reasons of solidarity but self-interest.

The $47 billion health ministry is unlike any other, soaking up the biggest share of government spending (42 per cent). And it is under immense pressure to rein in costs without reducing care.

Matthews is one of the strongest performers on a front bench that is hardly brimming with political talent. She sits beside McGuinty in the House, and the premier’s office long ago pegged her as best-suited to lead reforms in the volatile health sector by disarming major interest groups and empathizing with patients.

Then ORNGE happened on her watch.

No politician could realistically keep a close eye on a stand-alone air ambulance service while also overseeing hospitals, physicians, nurses, drug programs, cancer treatment, mental health and addiction services. Any minister who made helicopters their priority would do a disservice to everything else.

So who should answer for the bitter taste of ORNGE?

It certainly was not the minister’s finest hour. She didn’t heed early hints from MPPs who queried its lack of transparency (though they had no smoking guns at that point). Matthews promised to get back to them, and didn’t.

Bureaucrats who were tipped off to financial irregularities also dropped the ball. And the original decision to spin off the old government-run air service, under former health minister George Smitherman, lacked a solid framework of accountability.

But Matthews has rebounded — regaining control over the rogue ORNGE since it hit the front pages of the Star. She sidelined its infamous CEO Chris Mazza, he of the $1.4 million salary (not counting bonuses, loans and smoothies). She ordered ORNGE to show her the money after months of double-talk and double-dealing. She dumped the board of directors, wound up its errant for-profit subsidiaries, ordered in forensic auditors, opened doors for the auditor general and called in the OPP.

She did much of that without any legal authority to force compliance — due to the Frankenstein framework created by Smitherman years before — instead relying on moral suasion to get the ORNGE board to bend to her will. Arguably, she has made up for early mistakes.

Then there is her other day job — steering the major reforms facing the health ministry. On Thursday, for example, high-stakes negotiations open with the province’s powerful doctors on a new fee schedule that the Liberals want to keep frozen.

If Matthews departs, it would take months for her replacement to get up to speed in a ministry that eats ministers for breakfast.

Her predecessor, David Caplan, was chewed up when he took a bullet for the eHealth scandal. Caplan was forced to resign for the mistakes of Smitherman before him, but the real reason he was sacrificed was to protect McGuinty (the auditor general was drawing a link to the premier’s office).

Once again, the auditor general is on the trail. This time, McGuinty’s fingerprints aren’t on the ORNGE file, so he needn’t offer up a ministerial sacrifice — for now. But if the auditor finds egregious neglect, Matthews will once again be on the firing line.

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